Suassuna, Gabriel Vitório De Araújo; Midena, Clara Medeiros; Bandeira, Wigínio Gabriel De Lira; Montello, Mauro Bezerra; Abreu, Bento João Da Graça Azevedo; Cavalcante, Judney Cley; Abstract Knowledge of vascularization is essential for surgical planning and interventional procedures in the axillary region. The axillary artery gives off branches supplying the shoulder, thoracic wall, and scapula. It then continues as the brachial artery, which furnishes branches to the arm and elbow. Minor variations in these branches are common. However, dissection of a formalin-fixed right upper limb revealed an axillary artery that bifurcated into a superficial brachial artery, which did not give off any branches, and a posterior trunk, that gave rise to all the branches typically originating from the third part of the axillary artery and the brachial artery, including the subscapular artery, the humeral circumflex arteries, the deep brachial artery, and the collateral ulnar arteries. This rare vascular arrangement has not been previously described in Brazil. Awareness of these variations may prevent diagnostic errors and injuries during surgeries.

Dionisio, Felipe Carrasco Ferreira; Silva, Pedro Henrique Amaral Ângelo Da; Moreira, Bruno Lima; Medeiros, Augusto Kreling; Resumo O defeito do septo atrial (DSA) é um defeito cardíaco comum, com implicações significativas se não tratado. Embora a cirurgia aberta seja uma abordagem tradicional, os dispositivos de fechamento transcateter, como os dispositivos oclusores septais Amplatzer™, têm ganhado destaque devido às vantagens, como menor tempo de internação e custos reduzidos. Dentre suas possíveis complicações, a migração do dispositivo é uma complicação rara, com uma incidência de 0,5 a 1,1%. Relatamos um caso raro de migração de um dispositivo Amplatzer™ em um paciente assintomático, diagnosticado no sexto mês posterior à sua implantação. Após a detecção do problema, a equipe médica optou pela remoção percutânea do dispositivo, seguida de cirurgia aberta para corrigir o DSA. A avaliação por métodos de imagem desempenhou um papel crucial na determinação do plano de tratamento. Em suma, o manejo de embolização de dispositivos Amplatzer™ requer consideração cuidadosa das circunstâncias do paciente e da anatomia do dispositivo. Este caso destaca a importância da correlação clínica e de imagem na escolha da abordagem terapêutica e a viabilidade de uma abordagem menos invasiva em casos de migração tardia.

Shetty, Surekha Devadasa; Padur, Ashwini Aithal; Marpalli, Sapna; Nayak, Satheesha Badagabettu; Abstract A sound knowledge of variations in the branching pattern of the abdominal aorta is crucial for operative, diagnostic, and endovascular procedures. We report a unilateral anomalous lateral branch of the abdominal aorta observed during dissection classes.This anomalous branch took origin from the anterior surface of the abdominal aorta behind the left renal vein and pierced the left renal vein. After piercing the left renal vein, it traced a tortuous course through the peri-renal fat pad in front of the lower part of the left kidney. The artery then ran downward and laterally, pierced the anterior layer of thoracolumbar fascia, and continued to the posterior abdominal wall to supply its muscles. It also supplied the fat and fasciae around the kidney. Such an anomalous lateral branch could bleed significantly during renal surgery. It could also mislead radiologists during the invasive radiologic procedures.

Gunawardena, Thilina; Abstract Aneurysms of arteries of the hand are rarely encountered. Literature reports such aneurysms in the distal ulnar artery, the palmar artery, and the digital arteries. Most are false aneurysms involving trauma-induced defects of the vessel wall. True aneurysms with intact intimal, medial, and adventitial layers of the arterial wall are more unusual. In this case report, we present a 77-year-old previously healthy lady who was diagnosed with a true aneurysm of a common digital artery when she presented with a pulsatile lump over her left palm.

Borthakur, Dibakar; Sehgal, Ritu; Rani, Neerja; Kumar, Rajesh; Kumar, Rakesh; Dada, Rima; Abstract Horseshoe kidney (HSK) is a rare congenital malformation of the kidney with reported prevalence between 1 in 600 and 1 in 400. A typical HSK has two lower poles fused across the midline in front of the abdominal aorta just below the origin of the inferior mesenteric artery. Very rarely, the upper poles may fuse resulting in a reverse HSK. It is more common in males than in females, but no definite racial or genetic predilection has been established. The HSK is frequently associated with other congenital anomalies, the most common being vascular anomalies. This report describes HSK in a 73-year-old male cadaver, with triple renal arteries and aberrant right testicular artery originating from the ipsilateral renal artery and bilateral extra-renal calyces. Although rare in occurrence, a surgeon must bear in mind that such a combination of anomalies may pose technical difficulties during open or laparoscopic abdominal surgeries.

Santos, Vanessa Prado Dos;

Góes Junior, Adenauer Marinho De Oliveira; Aita, Clarisse Gripp; Brito, Sellena Polyana Soares De Souza; Feijó, Fernanda Beatriz De Albuquerque; Feijó, Matheus Oliveira; Albuquerque, Flávia Beatriz Araujo De; Resumo No presente estudo, descreve-se o caso de um paciente que desenvolveu síndrome compartimental nos membros inferiores após o uso de dispositivo de compressão pneumática intermitente e meias elásticas como método de profilaxia para tromboembolismo venoso no perioperatório de cirurgia plástica. O paciente foi tratado com fasciotomias e evoluiu sem intercorrências. Ademais, apresenta-se uma revisão da literatura sobre o diagnóstico e o tratamento da síndrome compartimental dos membros inferiores, assim como os mecanismos fisiopatológicos desta condição clínica como complicação pós-operatória.

Faria, Valéria Cristina De; Fernandes, Juliana Simões De Alencar; Cunha, Tulio Ericles De Oliveira; Pussieldi, Guilherme De Azambuja; Pereira, Danielle Aparecida Gomes; Abstract Background Early recognition of peripheral tissue perfusion deficits can minimize secondary complications of peripheral arterial disease in individuals with diabetes. Objectives To compare parameters of peripheral tissue perfusion in the leg at rest and during and after progressive effort between non-diabetics and individuals with type 2 diabetes and normal ankle brachial index values, as well as to evaluate the factors associated with peripheral tissue perfusion in the leg in individuals with type 2 diabetes during progressive effort. Methods This cross-sectional study included 31 individuals with type 2 diabetes and 31 non-diabetics. Anthropometric measurements and physical activity levels were assessed in all individuals. Peripheral tissue perfusion was analyzed using near-infrared spectroscopy during an arterial occlusion maneuver and the Incremental Shuttle Walking Test. Results During progressive effort, the tissue oxygen saturation level was lower in the type 2 diabetes group (type 2 diabetes, 58.74 [56.27–61.74] than the non-diabetic group, 62.15 [59.09–66.49]; p = 0.005). There were significant correlations between tissue oxygen saturation during progressive effort and physical activity level (p < 0.0001; r = -0.681), total body fat percentage (p = 0.001; r = 0.590), segmental body fat percentage (p < 0.0001; r = 0.616), total skeletal muscle mass (p < 0.0001; r = -0.628), and segmental skeletal muscle mass (p = 0.001; r = -0.592). Conclusions Individuals with type 2 diabetes and normal ankle-brachial index values had worse tissue perfusion during progressive effort than non-diabetics, and there was an association between perfusion, physical activity level, and body composition in the type 2 diabetes group.

Perdigão, Kauane Flechas Arruda; Costa, Larissa Pereira; Freitas, Annicia Lins; Lima, José Heriston De Morais; França, Eduardo Ériko Tenório De; Pedrosa, Rafaela; Resumo Contexto A doença arterial obstrutiva periférica ocorre devido a afecções de artérias dos membros inferiores e está associada a elevadas taxas de mortalidade cardiovascular. Estudos mostram o exercício físico supervisionado como opção eficaz para o controle dos sintomas. Objetivos Identificar quais são os tipos de exercícios e terapias complementares, adicionais ao exercício físico supervisionado, utilizados para a reabilitação vascular de pessoas com doença arterial obstrutiva periférica e discutir sobre as melhores recomendações da literatura. Métodos Trata-se de uma revisão integrativa da literatura, construída baseada nas publicações dos últimos 5 anos. A busca ocorreu nas seguintes bases de dados: PubMed, SciELO, LILACS (Biblioteca Virtual da Saúde) e Cochrane. Foram incluídos ensaios clínicos dos últimos 5 anos, com intervenções adicionais ao exercício físico supervisionado ou outras abordagens que contribuíram para a reabilitação de pacientes. Foram excluídos artigos duplicados, sem texto completo disponível e sem informações relacionadas ao tema no título ou resumo. Resultados Foram incluídos nove artigos para análise. Os resultados apresentados mostram que o exercício físico supervisionado é um método de tratamento considerado padrão-ouro. Entretanto, terapias como restrição de fluxo sanguíneo, terapia do calor, hidroterapia e treinamento resistido podem auxiliar na melhora da adesão do paciente, e seus efeitos complementares trazem benefícios cardiovasculares e para a função física. Conclusões: A reabilitação com exercício físico em pacientes com doença arterial obstrutiva periférica é uma abordagem terapêutica fundamental. Todavia, o treinamento de resistência com restrição de fluxo sanguíneo pode otimizar a força muscular, enquanto a terapia do calor e hidroterapia podem agir como coadjuvantes do exercício físico.

Harduin, Leonardo De Oliveira; Barroso, Thiago Almeida; Guerra, Julia Bandeira; Filippo, Márcio Gomes; Almeida, Leonardo Cortizo De; Gama, Carlos Alexandre Rosa; Vieira, Brunno Ribeiro; Mello, Renata Silveira; Galhardo, Adriano Martins; Strogoff-De-Matos, Jorge Paulo; ABSTRACT Background Stenosis resulting from neointimal hyperplasia remains a significant concern associated with dysfunction of arteriovenous fistulas (AVF). Objectives To investigate the safety and efficacy of paclitaxel drug-coated balloon (DCB) angioplasty for treating failing AVFs. Methods Investigators analyzed 58 hemodialysis patients treated with RangerTM DCBs from December 2022 to December 2023 across four centers. Lesions treated were de novo or restenotic and located in the juxta-anastomosis, cannulation zone, and outflow segment. Patients were evaluated through physical examinations and Duplex ultrasound at 1, 3, and 6 months. The primary efficacy endpoint was target lesion primary patency at 1, 3, and 6 months, and the primary safety endpoint was freedom from serious adverse events through 30 days post-procedure. Secondary endpoints were access circuit primary patency and technical and procedural success. Results Nine patients (16%) had thrombosed access at the initial presentation, and 31 (53%) presented with recurrent stenosis. The target lesion primary patency rate at 6 months was 85.7%, and the access circuit primary patency rate at 6 months was 67.5%. No serious adverse events, either local or systemic, were reported. Sex, age, stenosis location, type of lesion, presence of thrombosis, lesion recurrence, diabetes status, or whether post-ballooning dilation was performed did not significantly affect the 6-month target lesion primary patency. Conclusions DCB angioplasty was shown to be safe and effective for treating peripheral stenosis in vascular access.